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JAMA Pediatrics Clinical Challenge

Newborn With Unexpected Skin Lesions

Image of figure 1


Lia Oliveira, MD
Isabel Castro Esteves, MD
Filipa Prata, MD
Cristina Tapadinhas, MD
Cristina Guerreiro, MD
José Gonçalo Marques, MD

A 25-day-old newborn was admitted to our hospital with a diagnosis of bronchiolitis. During admission, the infant developed violaceous skin lesions with edema in inguinal and axillary regions (Figure). Lesions became ulcerated within 3 to 4 days, with infarcted necrotic areas. Blood tests showed leukopenia (white blood cell count, 2460/μL) with neutropenia (neutrophil count, 220/μL) (to convert both to ×109 per liter, multiply by 0.001). The lesions were biopsied and samples were sent for cultures and histopathological analysis. Intravenous floxacillin was started, followed by surgical debridement due to progression of the major lesions.

His mother was addicted to drugs, she had a known hepatitis C virus infection, and the pregnancy was unsupervised. Thirteen days before delivery, she visited the emergency department with flulike symptoms. Routine infectious screening revealed negative serology for syphilis, hepatitis B virus, and human immunodeficiency virus (HIV) types 1 and 2 by enzyme-linked immunosorbent assay (ELISA). The infant was born at 40 weeks’ gestation by forceps delivery.

What is the most likely diagnosis?

See the full article for an explanation and discussion.

Author Affiliations: Oliveira (lcfoliveira@gmail.com) is affiliated with the Pediatric Department, Hospital de Santa Maria, Lisbon, Portugal; Esteves, Prata, and Marques are affiliated with Pediatric Infectious Diseases, Pediatric Department, Hospital de Santa Maria, Lisbon, Portugal; Tapadinhas is affiliated with the Dermatology Department, Hospital de Santa Maria, Lisbon, Portugal; and Guerreiro is affiliated with the Gynecology-Obstetrics Department, Alfredo da Costa Maternity Hospital, Lisbon, Portugal.